Greater Boston Urology Blog

What Are Varicoceles? The Tangled Tale of Troublesome Testicles

Dr. Natalya Lopushnyan is joining us for this blog post on varicoceles. She’s going to discuss what they are, their different grades, and when to consider treatment. headshot of female doctor, Natalya Lopushnyan

As with all content on our blog, the following is educational only, not medical advice. Always consult your physician about your specific healthcare needs.

Without further ado, here’s Dr. L, as her patients affectionately call her.


Today, we’re delving into the world of varicoceles—a peculiar condition that can affect you below the belt. Now, don’t you worry, we’ll navigate through this topic with ease and a sprinkle of fun. So let’s unravel the mystery behind varicoceles and understand what you need to know.

What are varicoceles?

Imagine a traffic jam, but instead of cars, it’s your blood vessels. Varicoceles are like that—a jumble of enlarged and twisted veins in the scrotum, affecting the testicles. These veins can create a little roadblock, causing occasional trouble for the boys downstairs.

What are the different “grades” of varicoceles?

Varicoceles come in three different sizes, or “grades,” which indicate their severity. And in this case, more is more: The higher the grade, the more significant the varicocele. 

  • Grade 1: The subtle varicocele. It’s like spotting a single car stuck in traffic—a small cluster of veins that can only be noticed if you are really looking for it.
  • Grade 2: The moderate varicocele. Now, we’re dealing with a few more cars clogging up the lane. These veins are larger and more noticeable without too much effort.
  • Grade 3: The heavy-duty varicocele. This is the full-blown rush-hour traffic situation. The veins are large, prominent, and hard to miss. They may even make the testicle feel like a bag of worms. Yikes!

Microscopic hematuria means you cannot see any change in the color of the urine, but there are at least three red blood cells that have been detected in your urine under the microscope per high-powered field.

When should varicoceles be fixed?

Ah, the million-dollar question! Not all varicoceles require immediate intervention. However, there are situations when action might be necessary:

  1. Symptoms: If you’re experiencing discomfort, pain, or heaviness in your scrotum, it’s worth investigating further. Varicoceles can sometimes cause these symptoms. Treating them may bring you sweet relief.
  2. Fertility Concerns: Varicoceles have been associated with reduced fertility. If you and your partner are trying to conceive and facing difficulties, it’s worth checking if varicoceles are playing a role. Fixing them might give your swimmers a better chance at reaching their destination.
  3. Testicular Atrophy: In some cases, a varicocele can cause the affected testicle to shrink over time. If you notice any changes in size or texture, it’s essential to get it checked out. Timely treatment can potentially prevent further shrinkage. This is especially important for teenagers and young people.

How are varicoceles treated?

Fear not, my friends! We have options to tackle those pesky varicoceles:

  1.  Watchful Waiting: For grade 1 or 2 varicoceles or cases without bothersome symptoms, we may opt for a wait-and-see approach. Regular monitoring and lifestyle modifications, such as wearing supportive underwear or avoiding activities that exacerbate symptoms, might be recommended.
  2.  Surgical Intervention: When varicoceles are causing discomfort, impacting fertility, or leading to testicular atrophy (testicles shrinking), surgery may be the way to go. The most common procedure is called varicocelectomy, where the tangled veins are surgically tied off by your urologist under a microscope.
  3. Embolization: Another option is varicocele embolization. In this procedure, a radiologist inserts a small catheter into the affected vein and blocks it using tiny coils or other substances. It’s like building a roadblock for the traffic jam!

Remember, each treatment option has its pros and cons, and the choice depends on factors like your symptoms, fertility goals, and overall health. Consulting with a urologist will help guide you towards the best decision. 

If you're dealing with scrotal issues like varicoceles, we can help.

Our world-class physicians can help diagnose and treat scrotal conditions like varicoceles. Request an appointment and let us help.


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